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See detailSingle center experience in 157 controlled DCD-liver tranplantation
Schielke, Astrid Anita ULiege; Paolucci, M; MEURISSE, Nicolas ULiege et al

Conference (2019, May 16)

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and ... [more ▼]

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and retransplantation. The authors retrospectively reviewed a single centre experience with controlled DCD-LT in a 15-year period. Patients and Methods: 157 DCD-LT were consecutively performed between 2003 and 2017. All donation and procurement procedures were performed as controlled DCD in the operating theatre. Data are presented as median (ranges). Median donor age was 57 years (16-83). Median DRI was 2.242 (1.322-3.554). Allocation was centre-based. Median recipient MELD score at LT was 15 (6-40). Mean follow-up was 37 months. No patient was lost to follow-up. Results: Median total DCD warm ischemia was 19 min (7-39). Median total ischemia was 313 min (181-586). Patient survivals were 89.8%, 75.5% and 73.1% at 1,3 and 5 years, respectively. Graft survivals were 89%, 73.8% and 69.8% at 1,3 and 5 years, respectively. Biliary complications included mainly anastomotic strictures, that were managed either by endoscopy or hepatico- jejunostomy. Two patients were retransplanted due to intrahepatic ischemic lesions. Conclusion: In this series, DCD LT provides results similar to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. [less ▲]

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See detailEarly listeriosis after liver transplantation: report of two cases
Piette, E; VANDERMEULEN, Morgan ULiege; MEURISSE, Nicolas ULiege et al

in Transplant Infectious Disease (2019)

Listeria monocytogenes is a rare cause of potentially lethal infection and sepsis in transplant recipients. Listeriosis is usually described after kidney or bone marrow transplant, and has been less ... [more ▼]

Listeria monocytogenes is a rare cause of potentially lethal infection and sepsis in transplant recipients. Listeriosis is usually described after kidney or bone marrow transplant, and has been less frequently reported after liver transplantation. Here, the authors present two cases of severe Listeria infection occurring within four months after complicated liver transplantation in patients still recovering on the ward. The patients were successfully treated by intravenous ampicillin. These cases should remind transplant physicians that listeriosis may develop in liver transplant recipients, that food safety advice should be provided, and that intravenous ampicillin might be an effective treatment for systemic listeriosis in solid organ recipients. It is likely that trimethoprim-sulfamethoxazole prophylaxis might help prevent early listeriosis after solid organ transplantation. [less ▲]

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See detailA single center experience with 157 controlled DCD liver transplantation
Schielke, Astrid Anita ULiege; Paolucci, M; MEURISSE, Nicolas ULiege et al

Conference (2019, March 14)

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and ... [more ▼]

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and retransplantation. The authors retrospectively reviewed a single centre experience with controlled DCD-LT in a 15-year period. Patients and Methods: 157 DCD-LT were consecutively performed between 2003 and 2017. All donation and procurement procedures were performed as controlled DCD in the operating theatre. Data are presented as median (ranges). Median donor age was 57 years (16-83). Median DRI was 2.242 (1.322-3.554). Allocation was centre-based. Median recipient MELD score at LT was 15 (6-40). Mean follow-up was 37 months. No patient was lost to follow-up. Results: Median total DCD warm ischemia was 19 min (7-39). Median total ischemia was 313 min (181-586). Patient survivals were 89.8%, 75.5% and 73.1% at 1,3 and 5 years, respectively. Graft survivals were 89%, 73.8% and 69.8% at 1,3 and 5 years, respectively. Biliary complications included mainly anastomotic strictures, that were managed either by endoscopy or hepatico-jejunostomy. Two patients were retransplanted due to intrahepatic ischemic lesions. Discussion: In this series, DCD LT provides results similar to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. [less ▲]

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See detailEarly listeriosis after liver transplantation: report of 2 cases
PIETTE, E; VANDERMEULEN, Morgan ULiege; MEURISSE, Nicolas ULiege et al

Poster (2019, March 14)

Listeria monocytogenes is a rare cause of potentially lethal infection and sepsis in transplant patients. Listeriosis is usually described after kidney or bone marrow transplant, and has rarely been ... [more ▼]

Listeria monocytogenes is a rare cause of potentially lethal infection and sepsis in transplant patients. Listeriosis is usually described after kidney or bone marrow transplant, and has rarely been reported after liver transplantation. Here, the authors present two cases of severe Listeria infection occurring within three months after complicated liver transplantation in patients still recovering on the ward. The patients were successfully treated by intravenous ampicillin. These cases should remind transplant physicians that listeriosis may develop in liver recipients, that food safety advice should be provided, and that intravenous ampicillin might be an effective treatment for systemic listeriosis in solid organ recipients. [less ▲]

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See detailHepatic alveolar echinococcosis.
DETRY, Olivier ULiege; MEURISSE, Nicolas ULiege; Delwaide, Jean ULiege et al

in Acta Chirurgica Belgica (2018), 118(3), 200-201

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See detailA SINGLE CENTER EXPERIENCE WITH 157 CONTROLED DCD-LIVER TRANSPLANTATIONS
Schielke, Astrid Anita ULiege; Paolucci, Maite; MEURISSE, Nicolas ULiege et al

Conference (2018, November 29)

But du travail: Rapporter une expérience monocentrique de 14 ans de transplantation hépatique (TH) à partir de donneurs en mort circulatoire de type III (DMC III) de Maastricht. Méthodes : 157 TH DMC III ... [more ▼]

But du travail: Rapporter une expérience monocentrique de 14 ans de transplantation hépatique (TH) à partir de donneurs en mort circulatoire de type III (DMC III) de Maastricht. Méthodes : 157 TH DMC III ont été réalisées entre 2003 et 2017. Tous les prélèvements ont été réalisés sur des DMC III dont les soins ont été interrompus en salle d’opération. Aucune perfusion normothermique n’a été utilisée dans cette série. Les données sont présentées en médiane et extrêmes. L’âge des donneurs étaient de 57 ans (16-84). L’âge des receveurs était de 60 ans (21-74), avec un score MELD de 15 (6-40). Le suivi était de 37 mois (6-180). Résultats : L’ischémie chaude totale de prélèvement (de l’arrêt du support respiratoire à la perfusion aortique) était de 19 min (7-39). L’ischémie froide était de 237 min (105-576). Le pic d’ASAT était de 978 U/L (67-21.510). La survie des patients et de greffons étaient de 89,8%, 75,5% and 73,1 % et 89%, 73,8% and 69,8%, à 1, 3 et 5 ans, respectivement. La plupart des complications biliaires ont été des sténoses anastomotiques traitées par voie endoscopique, et 2 patients ont été re-transplantés pour des lésions ischémiques intra-hépatiques diffuses. La majorité des décès étaient dus à des causes néoplasiques (récidive de carcinome hépatocellulaire ou tumeur de novo). Conclusions : cette expérience nous encourage à continuer l’utilisation des DMC III pour la TH. Une ischémie froide courte et une sélection des patients avec des MELD peu élevé peut en partie expliquer ces bons résultats. [less ▲]

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See detailAlveolar echinococcosis in southern Belgium: retrospective experience of a tertiary center.
Cambier, Audrey ULiege; LEONARD, Philippe ULiege; Losson, Bertrand ULiege et al

in European Journal of Clinical Microbiology and Infectious Diseases (2018), 37(6), 1195-1196

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See detailLiver transplantation in Jehovah’s Witnesses: a single center-experience
VANDERMEULEN, Morgan ULiege; MEURISSE, Nicolas ULiege; DAMAS, Pierre ULiege et al

Conference (2018, March 15)

For religious reasons most of the Jehovah's witnesses (JW) refuse infusions of any blood product, including autologous or homologous pre-donated blood, platelets, fresh frozen plasma. However, they may ... [more ▼]

For religious reasons most of the Jehovah's witnesses (JW) refuse infusions of any blood product, including autologous or homologous pre-donated blood, platelets, fresh frozen plasma. However, they may accept solid organ transplantation. The authors report their experience of liver transplantation (LT) in JW over a 20-year period. [less ▲]

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See detailPrise en charge multidisciplinaire de l'echinococcose alveolaire : le groupe Echino-Liege.
Cambier, Audrey; GIOT, Jean-Baptiste ULiege; LEONARD, Philippe ULiege et al

in Revue Médicale de Liège (2018), 73(3), 135-142

Alveolar echinococcosis is a zoonotic disease due to the tapeworm Echinococcus multilocularis. The definitive host is the red fox. Until recently, Belgium was considered a country at very low risk for ... [more ▼]

Alveolar echinococcosis is a zoonotic disease due to the tapeworm Echinococcus multilocularis. The definitive host is the red fox. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis. However, recent studies carried out in southern Belgium have revealed, through post-mortem examination, high prevalences (up to 62 %) in foxes. Cats and dogs can act as definitive hosts. Human are accidentally infected by ingestion of food contaminated by the feces. After a long incubation period, invasive hepatic lesions may appear, as well as extra-hepatic lesions. The disease may be fatal. The diagnosis is based on imaging techniques, serology and nucleic acid detection in tissues. Early diagnosis may allow surgical removal of the lesion associated with at least 2 years of albendazole postoperative treatment. In case of contraindication to surgery, a long term treatment with albendazole is necessary. Liver transplantation is sometimes necessary. This article presents the epidemiologic, clinical, diagnostic and therapeutics features of this zoonotic disease. [less ▲]

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See detailLiver transplantation in Jehovah's witnesses
VANDERMEULEN, Morgan ULiege; MEURISSE, Nicolas ULiege; DAMAS, Pierre ULiege et al

in Acta Gastro-Enterologica Belgica (2018, January), 81(1), 30

Introduction: Liver transplantation (LT) is a major surgical procedure with large dissections and sutures of large vessels in patients with high portal hypertension and low levels of platelets and ... [more ▼]

Introduction: Liver transplantation (LT) is a major surgical procedure with large dissections and sutures of large vessels in patients with high portal hypertension and low levels of platelets and coagulation factors. In consequence, LT often requires large amounts of blood products. For religious reasons, most Jehovah's witnesses (JW) refuse infusions of any blood product, including autologous or homologous pre-donated blood, platelets, fresh frozen plasma, coagulation factor concentrates, or human albumin. However, they may accept solid organ transplantation, including LT. Aim: The authors developed experience in abdominal and oncological surgery in JW and present here their results with LT in JW patients. Methods: Over a 20-year period, 22 LT (16 DBD, 2DCD, and 4 LRLT with JW living donors) were performed in 21 JW patients and were analyzed retrospectively. All patients received perioperative iron supplementation and erythropoietin. Two patients had percutaneous spleen embolization to increase platelet level. Anti-fibrinolytic (aprotinin or tranexamic acid) was administrated during LT and meticulous surgical hemostasis was achieved, helped by argon beam coagulation. Continuous circuit cell salvage and reinfusion whereby scavenged blood was maintained in continuity with the patient's circulation, was used in all patients. Veno-venous bypass was avoided during LT to minimize the coagulation disorders. Results: There were 10 male and 11 female patients whose mean age was 48 years (ranges: 6-70). Indications for LT were HCV with (3) or without (1) HCC, PBC (2), PSC (1), HBV (2), autoimmune hepatitis (1), antitrypsin deficiency (1), sarcoidosis (2), amyloidosis (3), polycystic liver disease (1), alcoholic cirrhosis with HCC (1), cryptogenic (3), hepatic artery thrombosis (1). At transplant, mean pre-operative hematocrit was 41% (ranges: 22-50), mean platelet level was 140x103/mm3 (ranges: 33-355), and mean INR was 1.25 (ranges: 0.84- 2.18).One LRLT recipient died at day 11 from aspergillosis and anemia, and another DBD recipient at day 28 due to complications after hepatic artery thrombosis. One patient finally accepted to be transfused for severe anemia. The mean hospital stay was 31 days (10-137). Kaplan-Maier patient survival was 85%, 72%, 72% at 5, 10 and 15 years, respectively Conclusions: According to the authors' experience, LT may be successful in selected and prepared JW patients who should not be a priori excluded from this life saving procedure. The indications for LT in JW were quite different from the common indications for LT, with a low rate of alcoholic cirrhosis. The experience with this particular group of patients helped the team to reduce transfusion needs in the non-JW patients. [less ▲]

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See detailAlveolar echinococcosis is now endemic in southern Belgium
Cambier, A; Leonard, Philippe ULiege; Losson, Bertrand ULiege et al

in Acta Gastro-Enterologica Belgica (2018, January), 81(1), 31

Introduction: Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis (AE). However it was recently demonstrated by necropsy series that up to 51% of the red foxes (Vulpes ... [more ▼]

Introduction: Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis (AE). However it was recently demonstrated by necropsy series that up to 51% of the red foxes (Vulpes vulpes) may be infected by E. multilocaris in some parts of Southern Belgium. The first local Belgian human AE cases were described in the early 2000's. Aim: The aim of this study was to report the experience of a tertiary university hospital of Southern Belgium with AE management. Methods: The authors retrospectively collected data from the parasitology laboratory (serologies), the hospital pharmacy in charge of supplying albendazole, and by searching through patient’s files with medico-economic information service of a tertiary university hospital. The medical files were retrospectively reviewed. Results: Twenty-one cases (66% male) of local AE have been recorded from 1999 to 2016. All patients were Belgian citizens with more than 30 years of life in Southern Belgium (Liege province: 10 cases (47.4%), Luxembourg province: 8 cases (36.8%), Namur Province: 3 cases (15.8 %)). Mean age of diagnosis was 66 years (ranges: (35-85y). Eighteen patients had hepatic involvement: 14 underwent surgical resection and 5 had unresectable liver lesions and underwent albendazole palliative therapy until death. During the same period, the faculty of veterinary medicine observed an increased rate of lethal hepatic AE in dogs, another indication of high AE incidence. Conclusions: AE appears to be spreading in Belgium and has actually an uneven geographical distribution with endemicity in areas of Southern and Eastern Belgium. However, it is probable that local AE cases will be diagnosed in the whole country, considering that there is no reason that infected foxes remain in Southern Belgium and also the fact that some people from Northern Belgium might spend long period in Southern Belgium, with or without their dogs. The liver is the most frequently involved organ and the only cure can be achieved by complete R0 resection of all AE lesions. In reaction to this experience, the authors created a multidisciplinary group for AE diagnosis and management, including hepatologists, infectiologists, microbiologists, pathologists, radiologists, nuclear medicine specialists, surgeons and veterinarians. The authorities should be aware of this medical issue and should facilitate the access to Albendazole for AE patients. A complete national survey should be encouraged, and BASL might have an important role in this study. [less ▲]

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See detailSurgical factors and not donor type per se are risk factors for acute kidney injury after liver transplantation
MEURISSE, Nicolas ULiege; Smet, Heloise ULiege; LEDOUX, Didier ULiege et al

in Transplant International (2017, September), 30(S2), 106-107298

Background: Because Liver Transplantation (LT) using DCD has been shown to be risk factor for Acute Kidney Injury (AKI), we reviewed results at our center. Patients and Methods: AKI was defined as ... [more ▼]

Background: Because Liver Transplantation (LT) using DCD has been shown to be risk factor for Acute Kidney Injury (AKI), we reviewed results at our center. Patients and Methods: AKI was defined as decrease >50% eGFR (CKD- EPI) within 48 h postreperfusion (RIFLE). 106 first LT-only [63 DBD (59%) & 43 DCD (41%)] without pre-existing renal dysfunction (eGFR>60 ml/min/1,73 m2, no renal replacement therapy) were performed from 2012 to 2016. Incidence/ risk factors for AKI were assessed. Data: mean (IQR). Results: Incidence of AKI was 33% (35/106). AKI-patients were more hospitalized before LT [9/16 (56%) vs 26/89 (29%), p < 0.01], with higher labMELD [16 (10–23) vs 12 (8–16), p = 0.01]. Donor type [11/43 DCD (25%) vs 24/63 DBD (39%), p = 0.16], donor hepatectomy time [38 min (26–50) vs 35 (25–42), p = 0.37], cold ischemic time [6 h (4.1–7.6) vs 5.1 (3.4–6.4), p = 0.21], time for anastomosis [44 min (35–49) vs 42 (38–48), p = 0.53], postreperfusion syndrome [19/46 (42%) vs 27/46 (58%), p = 0.07] were similar between AKI & non-AKI groups. AKI was more frequent if lungs were procured first in the donor [23/48 (48%) vs 11/56 (19%), p < 0.01]. Recipient surgery was longer in the AKI group [5.2 h (3.9–6.3) vs 4.3 (3.4–4.8), p < 0.01]. AKI was more frequent if platelets were transfused during LT [19/42 (56%) vs 15/59 (44%), p = 0.03]. Blood volume administrated from the cellsaver was larger in the AKI-patients [834 ml (300–750) vs 408 (0–550), p = 0.03]. AKI-patients have a higher peak AST [1235 U/L (310–1858) vs 812 (429–978), p = 0.04]. Haemoglobin [8.8 g/dl (7.4–9.9) vs 10 (8.5–11.7)] & platelets [69x103 (50 9 103–87 9 103) vs 89 9 103 (50 9 103–118 9 103)] at day 1 postreperfusion were significantly lower if AKI occurred. After multivariable analysis, thoracic procurement before liver [OR 5.75 (1.76–18.77), p = 0.004] & recipient surgery duration [OR 1.64 (1.15–2.32), p = 0.006] were only risk factors for AKI. Conclusion: Rapid donor/recipient surgery and not donor type are key factors to prevent AKI-post-LT. [less ▲]

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See detailUne série consécutive de 125 greffes hépatiques à partir de donneurs cadavériques en mort circulatoire
DETRY, Olivier ULiege; MEURISSE, Nicolas ULiege; HANS, Marie-France ULiege et al

in Transplant International (2017, January), 30(Suppl 1), 2481

Introduction: Donation after circulatory death (DCD) has been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and ... [more ▼]

Introduction: Donation after circulatory death (DCD) has been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and retransplantation. The authors retrospectively reviewed a single centre experience with controlled DCD-LT in a 14-year period. Patients and Methods: 125 DCD-LT were consecutively performed between 2003 and 2016. All donation and procurement procedures were performed as controlled DCD in operative rooms. Data are presented as median (ranges). Median donor age was 56 years (16–84). Most grafts were flushed with HTK solution in the first part of experience, and more recently with IGL1. Allocation was centre-based. Median follow-up was 52 (1–164) months. No patient was lost to follow-up. Results: Median total DCD warm ischemia was 19 min (9–39). Median cold ischemia was 238 min (105–576). Patient survivals were 90.2%, 77.5% and 74.5 % at 1.3 and 5 years, respectively. Graft survivals were 87.7%, 76.3% and 73.2% at 1.3 and 5 years, respectively. Biliary complications included anas- tomotic strictures and extrahepatic main bile duct ischemic obstruction, that were managed either by endoscopy or hepatico-jejunostomy. No PNF was observed in this series and one graft was lost due to ischemic cholangiopathy. Discussion: In this series, DCD LT appears to provide results similar to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. [less ▲]

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See detailComment je traite... les cancers localises de l'oesophage. Etat actuel des donnees et strategie therapeutique. 2eme partie : l'interet des approches multimodales avec ou sans chirurgie.
VAN DAELE, Daniel ULiege; Honoré, Pierre ULiege; COLLIGNON, Joëlle ULiege et al

in Revue Médicale de Liège (2017), 72(4), 168-174

In recent years, the treatment of esophagus cancer has been completely changed, thus competing the dogma of surgery as the cornerstone treatment. Multimodality treatments as radio-chemotherapy directly ... [more ▼]

In recent years, the treatment of esophagus cancer has been completely changed, thus competing the dogma of surgery as the cornerstone treatment. Multimodality treatments as radio-chemotherapy directly followed by surgery, or delayed surgery, significantly improve patient survival compared to surgery alone. Neoadjuvant radiochemotherapy is associated with a higher complete pathologic response rate and improved survival compared to chemotherapy alone. Immediate surgery after radio-chemotherapy is challenged for patients who present a complete clinical response, especially in case of squamous cell carcinoma. Indeed, systematic resection is associated with a significant postoperative mortality rate and has not proven any survival advantage in complete clinical responders as opposed to delayed resection in case of locally persistent or recurrent disease. In squamous cell carcinoma, this could lead to organ preservation, thus avoiding the mortality and durable functional impairment of esophagectomy. This review will discuss the positioning of the multimodality treatment strategy with neoadjuvant radiochemotherapy and chemotherapy and also the strategy of organ preservation. [less ▲]

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See detailComment je traite... les cancers localises de l'oesophage. Etat actuel des donnees et strategie therapeutique. 1ere partie : le point sur les approches chirurgicales et non chirurgicales.
VAN DAELE, Daniel ULiege; Honoré, Pierre ULiege; COLLIGNON, Joëlle ULiege et al

in Revue Médicale de Liège (2017), 72(2), 58-63

Esophageal cancers represent a highly heterogeneous entity mixing two different tumour types : AdenoCarcinoma (ADC) and Squamous Cell Carcinoma (SSC). Developing in the same organ, they are very often ... [more ▼]

Esophageal cancers represent a highly heterogeneous entity mixing two different tumour types : AdenoCarcinoma (ADC) and Squamous Cell Carcinoma (SSC). Developing in the same organ, they are very often considered as a unique pathology and, consequently, the same therapeutic strategy is indiscriminately applied. Esophageal cancer treatments are particularly complex and require a multidisciplinary approach. Despite impressive advances in the tumour statidifaction, surgery, radiotherapy and chemotherapy, the overall prognosis remains grim even at an early stage of the disease. In order to improve the treatment of esophageal cancers and the patientaeuros survival, we need to consider that ADC and SCC represent two different pathologies requiring specific therapeutic strategies. This review in two parts will present recent data from clinical trials under the scope of tumour histology to set up dedicated therapeutic strategies. In this first part, we explain the restricted role of surgical resection, the prognostic factors and the results of exclusive combined chemotherapy and radiation in localized esophageal cancer. [less ▲]

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See detailInfusion of third-party mesenchymal stem cells after liver transplantation: a phase-1, open-label, clinical study
DETRY, Olivier ULiege; VANDERMEULEN, Morgan ULiege; DELBOUILLE, Marie-Hélène ULiege et al

in Transplant International (2015, November), 28(S4), 1027

Background: Mesenchymal stromal cells (MSC) are multipotent bone mar- row progenitors that have demonstrated significant immunosuppressive effects in various in vivo and in vitro studies. This study aimed ... [more ▼]

Background: Mesenchymal stromal cells (MSC) are multipotent bone mar- row progenitors that have demonstrated significant immunosuppressive effects in various in vivo and in vitro studies. This study aimed to be the first evaluation of the safety and tolerability of MSC infusion after liver transplantation in a prospective, controlled phase-1 study. Methods: 10 liver transplant recipients under standard immunosuppression (TAC-MMF-low dose steroids until day 30) received 1.5–3 9 106/kg third party MSC on post-operative day 3 ` 2. These patients were prospectively compared to a group of 10 control liver recipients. Primary endpoints were MSC infusion toxicity, and incidence of cancer and opportunistic infections at month 6. Secondary endpoints were patient and graft survivals and rejection at month 6, as well as the effects of MSC on recipients’ immune function and on immunohistology of at month 6 graft biopsies. Results: No MSC infusional toxicity was observed. Both groups were comparable in terms of donor and recipient characteristics. There was no difference in primary end-points between control and MSC groups. No patient developed de novo cancer. There was no statistical difference in patient and graft survivals or in rejection rates. There was no graft rejection in the MSC group. Month-6 graft biopsies were not different according to Banff and fibrosis scores. Discussion: This phase 1 study showed excellent tolerability and safety of a single infusion of third-party MSC after liver transplantation. There were no graft safety issues and no excess of immunosuppression after MSC injection. Further analyses of consequences of MSC injection on the immune profile are needed. The possibility of avoiding calcineurin-inhibitors with repeated MSC injections as main immunosuppressive therapy and/of tolerance induction by MSC infusion should be investigated by further studies. This study is in part supported by an ESOT Senior Clinical Research Grant and by the University of Liege. [less ▲]

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See detailA consecutive series of 100 controlled DCD liver transplantation
DETRY, Olivier ULiege; DE ROOVER, Arnaud ULiege; Ledinh, H et al

in Transplant International (2015, November), 28(S4), 109296

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and ... [more ▼]

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and retransplantation. The authors retrospectively reviewed a single centre experience with controlled DCD-LT in a 12-year period. Patients and Methods: 100 DCD-LT were consecutively performed between 2003 and 2014. All donation and procurement procedures were performed as controlled DCD in operative rooms. Data are presented as median (ranges). Median donor age was 57 years (16–83). Median DRI was 2.16 (1.4–3.4). Most grafts were flushed with HTK solution. Allocation was centre-based. Median recipient MELD score at LT was 15 (7–40). Mean follow-up was 35 months. No patient was lost to follow-up. Results: Median total DCD warm ischemia was 19 min (10–39). Median cold ischemia was 235 min (113–576). Median peak AST was 1132 U/l (282– 21 928). Median peak bilirubin was 28 mg/dL. Patient survivals were 90.7%, 75.5% and 70.7% at 1.3 and 5 years, respectively. Graft survivals were 88.7%, 72.1% and 67.1% at 1.3 and 5 years, respectively. Biliary complications included mainly anastomotic strictures and extrahepatic main bile duct ischemic obstruction, that were managed either by endoscopy or hepatico- jejunostomy. No PNF or graft loss due to ischemic cholangiopathy was observed in this series. Discussion: In this series, DCD LT appears to provide results similar to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. If symptomatic ischemic cholangiopa- thy is diagnosed, adequate management with endoscopy and surgical hepaticojejunostomy may avoid graft loss and retransplantation. [less ▲]

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See detailPrognostic value of (18)F-FDG PET/CT in liver transplantation for hepatocarcinoma.
Detry, Olivier ULiege; Govaerts, Laurence; De Roover, Arnaud ULiege et al

in World Journal of Gastroenterology (2015), 21(10), 3049-54

AIM: To evaluate the prognostic value of pretreatment FDG positron emission tomography computed tomography (PET-CT) in patients with hepatocarcinoma treated by liver transplantation (LT). METHODS: The ... [more ▼]

AIM: To evaluate the prognostic value of pretreatment FDG positron emission tomography computed tomography (PET-CT) in patients with hepatocarcinoma treated by liver transplantation (LT). METHODS: The authors retrospectively analyzed the data of 27 patients (mean age 58 +/- 9 years) who underwent FDG PET-CT before LT for hepatocarcinoma. Mean follow-up was 26 +/- 18 mo. The FDG PET/CT was performed according to a standard clinical protocol: 4 MBqFDG/kg body weight, uptake 60 min, low-dose non-enhanced CT. The authors measured the SUVmax and SUVmean of the tumor and the normal liver. The tumor/liver activity ratios (RSUVmax and RSUVmean) were tested as prognostic factors and compared to the following conventional prognostic factors: MILAN, CLIP, OKUDA, TNM stage, alphafoetoprotein level, portal thrombosis, size of the largest nodule, tumor differentiation, microvascular invasion, underlying cirrhosis and liver function. RESULTS: Overall and recurrence free survivals were 80.7% and 67.4% at 3 years, and 70.6% and 67.4% at 5 years, respectively. According to a multivariate Cox model, only FDG PET/CT RSUVmax predicted recurrence free survival. Even though the MILAN criteria alone were not predictive, it is worth noting that none of the patients outside the MILAN criteria and with RSUVmax < 1.15 relapsed. CONCLUSION: FDG PET/CT with an RSUVmax cut-off value of 1.15 is a strong prognostic factor for recurrence and death in patients with HCC treated by LT in this retrospective series. Further prospective studies should test whether this metabolic index should be systematically included in the preoperative assessment. [less ▲]

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See detailSimultaneous passenger lymphocyte syndrome and multiple alloimmunization against donor's blood group antigens after liver transplantation
MONFORT, Mélanie ULiege; HONORE, Pierre ULiege; GOTHOT, André ULiege et al

in Vox Sanguinis (2015), 109

Background If “passenger lymphocyte syndrome” (PLS) is a well-recognized complication in ABO mismatched solid organ transplantation, the coexistence of this reaction with recipient’s alloimmunisation ... [more ▼]

Background If “passenger lymphocyte syndrome” (PLS) is a well-recognized complication in ABO mismatched solid organ transplantation, the coexistence of this reaction with recipient’s alloimmunisation against multiple antigens expressed on the residual red blood cells in the graft is less common and unpredictable. Methods The receiver of an ABO minor mismatch liver graft from a cadaveric donor developed hemolytic anemia within 2 weeks after transplantation. The organ donor was of blood group O D+C+c+E+e+ K+k+ Le(a+b-) and the recipient, A1 D-C-c+E-e+ K-k+ Le(a-b-). The donor and recipient were both tested for irregular antibodies. Elution was performed on the recipient’s red blood cells (RBCs). Results None of the recipient and donor had irregular alloantibodies at the time of transplantation. On day 10, anti-A antibodies was detected in the recipient’s serum and eluted from his RBCs. At the same time, the patient developed multiple alloantibodies: anti-D, anti-C, anti-E, anti-K and anti-Lea against the donor’s erythrocyte antigens. Conclusion Although serological analysis and hemolytic parameters confirmed the diagnosis of PLS which required transfusion support, no sign of graft damage due to recipient’s immune reaction was detected. This case illustrates the required follow-up of the recipient after transplantation. [less ▲]

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